Case Manager (RN)

PIONEERS MEMORIAL HEALTHCARE DISTRICT•Brawley, CA

7d•$46 - $53•Onsite

About The Position

Coordinates, negotiates, procures, and manages the care of complex patients to facilitate achievement of quality, cost-effective patient outcomes. This role works collaboratively with the interdisciplinary team, both internal and external to the organization, and participates in quality improvement and evaluation processes related to the management of patient care.

Requirements

Two to five years of diversified, progressive experience in acute care and/or other settings within the continuum of care.
Current AHA Basic Life Support certificate required.
Bachelor’s Degree in Nursing, medicine, or related field.

Nice To Haves

Utilization review of discharge planning experience preferred.
Bilingual English and Spanish preferred.
Certification in Case Management (CCM) or comparable certification preferred.

Responsibilities

Conducts admission and concurrent utilization activities according to established criteria and guidelines (MCG, InterQual).
Assesses the multidimensional domains of physical, psychosocial, and emotional functioning & supports, and financial resources of the patient.
Identifies the need for case management services at multiple points within the health care continuum.
In collaboration with all members of the health care team, including the patient and/or decision makers, plans for high quality, realistic, and cost-effective/resources driven continuum of care arrangements for identified patients.
Makes appropriate referrals using available community/regional resources.
Develops a network of the usual services and disciplines required by patients.
Maintains a working knowledge and application of the requirements of payers most frequently seen within the population.
Complies with all payers’ contracts/programs including denial and appeal procedures.
Referrals to the next level of care will include direct communication with the facility representative.
Facilitates the transfer of necessary documents/data with the patient to the next level of care.
Concurrently analyzes variances from expected outcomes to determine the need for action.
Collaborates with all members of the health care team to document patient status and variances, working toward the achievement of patient goals/optimum quality and cost outcomes.
Maintains complete and disciplined documentation of Case Management activities.
Provides leadership by enhancing understanding of the integrated Case Management Process with all members of the health care team.
Conducts discharge planning interviews and completes appropriate assessment screen in EMR (Cerner etc).
Engages in emergency, fire, and disaster drills.
Demonstrates ability to care for and maintain equipment appropriately.
Attends mandatory classes as required.
Attends required staff meetings.
Is punctual and prompt for work.
Follows the policies and procedures for sick and unscheduled absences.
Adheres to PMH dress and grooming standards policy.
Completes in-services and health exams as required by accrediting agency, Department of Public Health and PMH.
Extends courtesy and congeniality.
Ensures confidentiality and adheres to the privacy act.
Assumes other responsibilities as assigned.